Business Loan Application
Business Name
Email:
example@example.com
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Business Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Industry Type:
Business Start Date:
-
Month
-
Day
Year
Date
Federal Tax ID:
State of Incorporation or Organization:
Annual Revenue:
How much capital do you need?
$5K - $50K
$50K - $100K
$100K - $250K
$250K - $500K
$500K - $1M
$1M +
What will the money be used for? (Check all that apply)
Working capital/cash flow
Equipment or inventory
Real estate / expansion
Pay off debt or taxes
Start-up costs
Other
Do you have any open MCAs or loan accounts?
Yes
No
Lender name & balance:
Lender name & balance:
Lender name & balance:
Lender name & balance:
Any bankruptcies, foreclosures, or repossessions in the last 5 years?
Yes
No
Owner Information
Name:
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Title:
Ownership Percentage:
Business start date under current ownership:
-
Month
-
Day
Year
Date
Home Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SSN:
Credit Score:
Last 3 to 4 Months Bank Statements:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Month-to-Date (Transactions for current month):
Browse Files
Drag and drop files here
Choose a file
Cancel
of
By signing below, the Applicant (the business entity and its signing owner/guarantor, jointly and severally) represents, warrants, and agrees that (1) All information and documentation submitted to Maple X Financial in connection with this commercial financing request is true, correct, complete, and not misleading in any respect. (2)Applicant will promptly notify Broker in writing of any material change in the Applicant’s financial condition or any information previously provided. (3) Applicant expressly authorizes Broker to share this application and all supporting documents with its employees, affiliates, funding partners, lenders, assignees, agents, and any other third parties Broker deems appropriate (collectively, “Funding Sources”) for the purpose of evaluating and sourcing commercial financing options.(4) Applicant authorizes each Funding Source to obtain credit reports, background reports, bank verifications, tax records, and any other information they require to evaluate this request. (5) The individual signing below is duly authorized to bind the Applicant business and any personal guarantor(s). (6) Applicant and each individual providing contact information hereby consents to receive telephone calls (including artificial, pre-recorded, or autodialed calls), text/SMS messages, and emails, and other communications from Broker and all Funding Sources regarding this application and related financing opportunities, even if the telephone number provided is on any federal, state, or internal Do-Not-Call list.
Signature
Continue
Continue
Should be Empty: